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ACPRC Cardiothoracic Study DayAudit Of The Physiotherapy Service For Patients
Undergoing Cardiac Surgery At Castle Hill Hospital
Transferring Evidence into practiceNicola Beaumont
Senior Physiotherapist Castle Hill Hospital, East Yorkshire
March 2007
Objectives
To explore the evidence base and evaluate our own service provision against this
Professional networking To implement change management in order
to benchmark physiotherapy service provision against current available evidence
Aims
Increase the appropriate utilisation of physiotherapy services
Improve the patient and carer experience A standardised physiotherapy service for
patients undergoing cardiac surgery with a routine recovery, where treatments are evidence based, thus maximising quality and effectiveness for all concerned
Formally Registering the Audit
CG1 form - Recommendation to involve user groups
Pt questionnairedeveloped
Permission granted
Project Planning document
The Audit Process Plan
Sample of 50 pt’s To collect baseline data
Gather the evidence
Evaluate the evidence
Implement changesAnd re audit
Previous Service
Invitation to attend pre op information day 1POD treatment on ICU Incentive spirometer 2POD and each day thereafter until discharge by
the physiotherapist, actively assessing and treating chests, performing DBEx’s and mobilising patients
Stairs assessment where necessary for function prior to discharge
Discharge advice in the form of discharge booklet
Aspects evaluated
Value of routine DBEx’s and chest physiotherapy post op
The most recommended methods of mobilising in preparation for discharge, including stair climbing and pacing techniques
Whether patients were happy with the amount and type of treatment and discharge information they were receiving
The relative value of each aspect covered at the pre operative education talk
Finding the evidence
Chest physiotherapy Literature review minimal evidence for the need for any active
chest care in routine post op cardiac patientsMobilisation Professional ‘consensus of opinion’ Interactive CSP website discussion forum
Implementing the evidence
Chest physiotherapy Withdraw post op chest care for routine
patients from 2PODMobilisation Introduction of Borg scale Pacing Stair climbing
Descriptive Statistics
Baseline Re Audit group
Number of pts 50 50 Average age of pts 65 yrs 71yrs
(39-88 yrs) (49-89yrs) Males 36 36 Females 14 14
Results – Pre/ Post Implementation of New Physiotherapy service
Baseline Re Audit groupMode number of days on treatment 4 days 4 days
Mode length of stay in hospital 4 days 5 days
Mode number of chest treatments 3 1
Mode number of mobility treatments 1 3
Number of patients who underwent 20% 64% formal stairs assessment
Results – Patients PerspectivePre operative education (VAS 1-10)
Baseline Re Audit group
Physiotherapy treatment 8 (4-10) 8 (4-10)administered during stay
Need for physiotherapy 9 (8-10) 9 (6-10)
Management of pain 9 (8-10) 9 (7-10)
Discharge Information 9(8-10) 9(7-10)
General Discharge advice 9 (8-10) 9 (8-10)
Satisfaction of number times seeing physiotherapist post op
Baseline Re Audit group
Yes 69% 87%
No 0 3%
Too often 0 0
Not often enough 17% 3%
Not answered 14% 7%
Any Aspects of Physiotherapy Patients not Satisfied with
Baseline Re Audit group
Yes 6.5% 0
No 76% 97%
Not sure 3.5% 0
Not answered 14% 3%
Received sufficient information regarding pacing
Baseline Re Audit group
Yes 66% 77%
No 14% 6%
Not answered 20% 13.5%
Not sure 0 3.5%
Did you have stairs to climb when you got home?
Baseline Re Audit group
Yes 48% 63%
No 34% 27%
Not answered 18% 10%
Any problems encountered climbing stairs after discharge
Baseline Re Audit group
Yes 11% 16%
No 63% 84%
Have you been referred to a cardiac rehabilitation programme
Baseline Re Audit group
Yes 38% 23.5%
No 55% 73%
Not answered 7% 3.5%
Further changes
Clinical effectiveness of Incentive Spirometers
Exercise diaries for patients Further investigation into the value/intensity
of circulatory exercises is recommended
Contact details
[email protected] [email protected] [email protected] Physiotherapy department Castle Hill Hospital Castle Road
CottinghamEast YorkshireHU16 5JQ
